Last week, the Centers for Disease Control and Prevention made a clear admission in an internal document that the highly contagious Delta variant had redrawn the lines of the coronavirus pandemic and required new public health measures such as universal masking requirements did. Or, as the agency put it in the document it received from the New York Times, “the war has changed”.
The news came as the first school districts prepared to reopen; Children in Atlanta and some of the suburbs are returning to the classroom this week.
In the past year, the extent to which schools are contributing to the spread of the virus and whether and when they should be closed has been controversial. To some parents, teachers, and officials, keeping schools open seemed like an unacceptable risk when a new, poorly understood virus was floating around. For others, however, it was school closings that were at greater risk – from learning losses, growing educational gaps, and deteriorating mental health, not to mention hardship for parents.
As the new school year begins, however, the CDC, the American Academy of Pediatrics, and many other experts agree that reopening schools should be a priority.
“We’re in a very different place than we were a year ago,” said Elizabeth Stuart, epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “We have very effective vaccines, we know a lot more about how to open schools safely, and I think we have an increased awareness of some of the challenges children face when they are not in a personal school.”
Just a few months ago, when vaccinations for people aged 12 and over were progressing steadily and new cases were falling, the stage seemed ready for an at least partial return to normal.
Delta has questioned that. Much is still unknown about the variant, including whether children are more affected than previous forms of the virus. And since vaccination rates are very uneven and most decisions are left to local officials, the variant adds new uncertainty to the upcoming school year – and makes it even more important for schools to take safety precautions when they reopen, scientists said.
“Delta, because it’s so contagious, has increased the stakes,” said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and vaccines expert at Vanderbilt University. “That makes all these details all the more important.”
Here you can find answers to some frequently asked questions.
What did we learn about the risk of transmission in schools?
Overall, studies suggest that – at least for the last year – school transmission was generally low when schools took basic precautionary measures.
Coronavirus Pandemic and Life Expectancy in the United States
“If you have masks and are even three feet apart, you will not see major outbreaks in schools,” said Dr. Yvonne Maldonado, Pediatric Infectious Disease Specialist at Stanford Medicine and Chair of the American Academy of Pediatrics Committee on Infectious Diseases. “There may be some broadcasts, but they will be relatively infrequent.”
Studies in North Carolina, Utah, Missouri, and elsewhere showed that when schools put multiple types of safety measures on top of each other – a combination of masking, symptom screening, distancing, improved ventilation, virus testing, hand washing, and dividing students into smaller groups – the transmission rates in schools were even lower than in the surrounding community.
“It’s actually safer for the kids at school than at home,” said Dr. Daniel Benjamin Jr., a pediatric infectious disease specialist at Duke University.
These low rates could be due in part to the fact that children under the age of 10 appear to be less likely to transmit the virus than older children and adults. Another factor, however, is that schools are, or can be, controlled environments and may have tighter security measures than the surrounding community, said Dr. Benjamin.
However, outbreaks have occurred in schools that have reopened without good containment measures. Israel’s first major school outbreak, which ultimately infected 260 people, came during a heatwave when officials temporarily lifted mask mandates and forced students into air-conditioned classrooms.
How does delta complicate the equation?
About twice as transmissible as the original version of the virus, Delta has led to an increase in infections and hospital stays, especially in areas of the country where vaccination rates are low. Recent data suggests that people infected with Delta may have a thousand times as many viruses – which could make them more contagious and longer – than those infected with the original version of the virus.
But many questions about the variant remain unanswered, including the exact risk in the school environment. What is clear, however, is that Delta is already fueling outbreaks in many American communities, increasing the risks for local schools.
“Schools are not islands, and if there is a large community diffusion, some of that diffusion will spill over to schools,” said Dr. Westyn Branch-Elliman, an infectious disease specialist at Harvard Medical School.
Aug. 2, 2021, 7:01 am ET
In a study conducted prior to the spread of Delta, British researchers found that the risk of school breakout increased by 72 percent for every five additional cases per 100,000 people in a community.
The good news is that since the start of last school year, the United States approved three highly effective emergency vaccines that are generally available for ages 12 and over.
The vaccines are not perfect. Some fully vaccinated people will get breakthrough infections, which are generally mild and rare. And those vaccinated people infected with Delta can carry high levels of the virus in their noses and throats, which means they can potentially easily pass it on.
But vaccines offer strong protection against the Delta variant. They reduce the chances of getting infected with the virus and protect against the worst consequences, including hospitalization and death.
Schools with high vaccination rates are likely to have far fewer people infected with the virus who carry or spread it in the classroom.
“It’s our best tool for controlling the virus,” said Justin Lessler, an epidemiologist at the University of North Carolina. “Even if it’s imperfect, it has a tremendous impact on reducing transmission and protecting people’s health.”
What does the CDC recommend?
Initially, CDC guidelines recommended that unvaccinated people aged 2 and over wear masks in schools. And they strongly implied that vaccinated students do not need to be masked in the classroom.
But last week, over concerns about Delta, the CDC revised its guidelines, recommending that everyone, regardless of vaccination status, should wear masks in schools this fall.
The agency recommends a layered approach to Covid precautions, suggesting schools combine multiple mitigation measures and encourage anyone eligible for vaccination to get vaccinated.
However, the guidelines also leave many decisions to local officials, who are supposed to make decisions about when to tighten or relax restrictions based on data on local case and vaccination rates.
What about states that prohibit mask requirements?
Some states, including some that are currently experiencing large surges – including Florida, South Carolina, and Texas – are making it difficult for schools to take protective measures. These three states, as well as a handful of others, have either banned or severely restricted the universal mask mandate.
That doesn’t necessarily mean that all schools in these states will have huge outbreaks, and even schools that do can have mostly mild or asymptomatic cases. But districts that open without security are at real risk, said Dr. Benjamin.
“Here’s another way of putting it,” he said. “When I grew up, I got away with driving in the back of a pickup all the time. But that doesn’t make children riding on the back of pickups a good national policy. “
With the patchwork of guidelines and uneven vaccination rates across the country, experts wouldn’t be surprised if school safety fluctuates sharply this fall. “I think there will be a risk of contagion if school districts decide not to follow recommendations,” said Dr. Maldonado.
As the pandemic continues to develop, schools and officials will have to make complicated decisions based on local conditions, including when to insist on certain precautions and when it is safe to lift them.
“We have to make nuanced decisions about what to do in schools,” said Dr. Branch-Elliman. “But that is a much more difficult public health message than polarized ‘schools are safe’ or ‘schools are unsafe’.”
What about unvaccinated elementary school students?
Although the exact timing is unclear, vaccines for some children under the age of 12 could be approved before the end of the year. Until then, however, elementary schools will be open and practically none of their students will be vaccinated. (Children taking the exams may have received the syringes.)
However, research shows that the virus is much less likely to cause serious illness in children. You are not fully protected; a small number of children can develop a rare but severe inflammatory disease, and some children with mild infections may experience long-term symptoms.
There’s still no good, solid data on how Delta affects young children, but there’s no evidence that Delta targets them specifically.
However, because large numbers of adults have been vaccinated, children can make up an increasing proportion of Delta cases. The infectiousness of the variant can also lead to more children becoming infected with the virus. There is also some new evidence that the variant causes more severe illness in adults.
Given these observations, and out of caution, it’s especially important for schools with young, unvaccinated students to take other precautions, including universal masking, experts said.
In schools or districts that do not have a mask requirement, parents can provide some protection by ensuring that at least their children wear masks in school, said Dr. Maldonado.
And adults can help protect younger children by getting themselves vaccinated. “The most important thing any community can do to reduce the risk in schools is vaccinating the entire community,” said Dr. Conductor.